Our Clues 11 Flashcards by HM Beyea

Virchow’s triad

Hypercoagulability
Stasis
Endothelial injury

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Primary causes of venous clots

Stasis
- promotes aggregation
- Tx: heparin

Endothelial injury
- high velocity blood flow
- injury promotes aggregation
- Tx: aspirin

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Right coronary infarct clue

Heart block
Slow HR with chest pain
Chest pain = “hippo on chest”

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Left coronary infarct clues

Sudden death
Congested HF
- lost >40%
- EF < 45%
Recurrent ventricular arrhythmias

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DOC for:
- generalized seizure
- temporal lobe seizure
- status epilepticus

Phenytoin
- blocks Na channels
- prevents depolarization
- SE: gingival hyperplasia, hirsutism

Carbamazepine
- blocks Na channels
- prevents depolarization
- SE: SIADH, aplastic anemia

Diazepam
- facilitates GABA to increase frequency
- only rectal suppositories

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DOC for absence seizures (thalamic seizures)

Ethosuximide
- blocks Ca-type T channels

(Thalamus and atrium use Ca to depolarize)

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What are the fat-soluble anesthetics?

What are the water-soluble anesthetics?

All anesthetics end in -caine

Fat-soluble -> amides -> two “i”s in name = lidocaine

Water-soluble -> esters = tetracaine

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Heart sounds: paradoxical S2 splitting

Aortic stenosis
or
Pulmonary HTN

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DOC for atrial fibrillation or atrial tachycardia

Verapamil
Diltiazem

Ca-channel blockers b/c atrium and thalamus use Ca to depolarize

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Heart sounds: soft S2

AR
PR

Aortic atresia
Pulmonary atresia

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Heart sounds: loud S1

Stiff valves bangs shut or one ventricle contracting harder

TS
MS

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Heart sounds: soft S1

TR
MR

Tricuspid atresia
Mitral atresia

Atresia d/t lack of apoptosis, leads to cyanosis at birth

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Heart sounds: midsystolic click

Mitral valve prolapse
- common in women
- faster S1 -> standing
- slower S2 -> lying down

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Heart sounds: ejection click during systole

AS
PS

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Heart sounds: opening snap during diastole

TS
MS

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Organs/tissues that do not require insulin

“BRICKLE”

Brain
RBC
Intestine
Cardiac muscle/cornea
Kidney
Liver
Exercising muscle

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4 ways that acidosis can kill/harm you

1) denatures proteins
2) causes hyperkalemia
3) kussmaul breathing
4) elevated GABA (inhibitory)

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Post MI (day 4-7)
- Complications with their symptoms

1) cardiac tamponade
(Die suddenly, distant heart tones)

2) ventricular aneurysm
(Double knock, pericardial knock)

3) VSD
(Murmur louder w/ exhale, does not radiate to axilla)

4) Peri-infarct Pericarditis
(Triphasic rub, pericardial rub)

5) mitral regurgitation
(Murmur radiates to axilla)

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Actions of angiotensin 2
(5)

1) Vasoconstrict arteries (incr TPR d/t NE)
2) Constricts efferent arteriole more than afferent arteriole in kidney
(Creates backpressure; re-establishes GFR)
3) stimulates aldosterone
(Reabsorbs Na; excretes K, H)
4) Stimulates aDH
5) stimulates thirst center in brain

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Characteristics of low volume state

Decr Na serum (dilutional)
Decr Cl serum (dilutional)
Decr K serum (renal + dilution)
Decr pH urine (aldosterone)

Incr pH serum (metabolic alkalosis)
Incr TPH

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Dx of low volume state with acidosis

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Diarrhea (normal AG)
Renal tubular acidosis type 2 (normal AG)
DKA (elev AG)

Dx of low volume state with high Na

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Diabetes insipidus
Elderly neglect

What type of endocrine secretion is:
GI somatostatin that only works on GI hormones?

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Paracrine
- secreted then only works in the vicinity

What type of endocrine secretion is:
Thymosin & Thymopoietin secreted by thymus, and only works on thymus?

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Autocrine
- secreted by the cell it works on

What type of endocrine secretion is: Sweat glands of skin, breast, eyelids, and ear?

Apocrine - tip of cell is secreted with the substance - 90% of sweat glands

What type of endocrine secretion is: Sweat glands of armpits and groin?

Holocrine - entire cell is secreted with the substance - 10% of sweat glands

What type of endocrine secretion is: Pancreatic enzymes secreted into the GI tract?

Exocrine - secreted into a cavity

What are functions of the spleen? (5)

Remove old RBCs Remove damaged cells Remove encapsulated organisms Remove nuclear material Secondary erythropoiesis, if you lose bone marrow

List tissues and/or organs where blood flow resistance is in series

“PLuKi LiSp” Placenta (nutrition) Lung (oxygenation) Kidney (afferent to efferent artery) Liver (portal to hepatic vein) Spleen (filtration) “Series wants to slow you down for a little to perform its function”

What is the diagnosis if the A-V oxygen is almost zero?

PDA (MCC in newborns) ASD VSD AVM (death from massive hemorrhage)

Dx of multiple AVMS in lungs

Osler-Weber-Rendu - continuous murmur - machinery-like murmur - to-and-fro murmur - multiple AVMs in lung - MCC of death is pulmonary hemorrhage

Dx of multiple AVMs in abdomen and brain

Von Hippel-Lindau - defect of VHL gene on short arm of chromosome 3 - high risk of renal cell carcinoma

Which factor does the most to regulate flow?

Radius

Dx of IgA nephropathy after gastroenteritis

Henoch-Schönlein Purpura (HSP) - only vasculitis with normal platelet count - Purpura from buttocks down - high incidence of intussusception

Dx of vasculitis with high platelet count

Kawasaki disease Tx: aspirin daily for 2 years minimum, flu shot yearly

Dx of vasculitis with auto-amputation of digits and history of smoking

Buerger’s disease - necrotizing vasculitis - increased incidence in smokers and Jews - repeated intermittent claudication of medium vessels

Dx with rash on palms and soles “TRiCKSSSSS”

“TRiCKSSSSS” - toxic shock syndrome - Rocky Mountain spotted fever i - Coxsackie A - Kawasaki disease - Strep pyogenes - scarlet fever - scalded skin syndrome - syphilis (secondary) - streptobacillus moniliformus (rat bite fever)

Dx of subacute endocarditis Attacks what valve?

Strep viridans Attacks mitral valve => mitral regurgitation Signs: - mycotic aneurysm (brain) - Roth spots (retina) - splinter hemorrhages (nail beds) - Osler’s nodes (painful) - Janeway lesions (painless)

What antiarrhythmics block Na and Ca together? For what do we need to give it?

Quinidines Procainamide Phenytoin Wolff-Parkinson-White

Dx of collagen vascular diseases with low complement, 2 weeks after vaccination

Serum sickness (High incidence with MMR)

Dx of anhedonia or failure to function for 2 weeks

Major Depressive Disorder - Sleep disturbance - Interest loss - Guilt or feelings of worthlessness - Energy loss - Concentration difficulties - Appetite or weight gain/loss - Psychomotor agitation - Suicidal thoughts

Dx of nephrotic syndrome 2 weeks after sore throat

PSGN - subendothelial humps on histology (Also seen in SLE) - strain 12 (90%) - low complement

Trinucleotide repeats (4)

Huntington Disease (CAG; caudate has decr ACh and GABA) Myotonic Dystrophy (CTG; cataracts, toupee, gonadal atrophy) Fragile X Syndrome (CGG; chin (protruding), giant gonads) Friedrich Ataxia (GAA; ataxic GAAit)

Aortic arches derivatives

1st: M structures -> maxillary artery 2nd: S structures -> stapedial artery 3rd: C is 3rd letter -> carotid artery (common & internal) 4th: on left -> aortic arch; on right -> subclavian 5th: adios 6th: pulmonary arteries & PDA

Dx of vasculitis with sudden severe asthma in young adult

Churg-Strauss Syndrome - p-ANCA positive - IgE w/ pulmonary infiltrates (PIE syndrome)

Dx of pulmonary infiltrates w/ eosinophilia

PIE syndromes - Churg-Strauss (= sudden, severe asthma in young adult) - Aspergillosis (= sudden, severe asthma in adult; moldy hay or basement) - Loeffler’s syndrome (= due to parasites)

Carcinoid syndrome is emitting what neurotransmitter? Leads to what heart sound pathology?

Serotonin Tricuspid stenosis

Dx of vasculitis involving lungs and kidneys w/o sinus involvement

Goodpasture’s - anti-glomerular basement membrane - type IV collagen - linear Immunofluorescence on EM

Dx of vasculitis leading to renal failure after eating raw hamburgers

Hemolytic uremic syndrome - MCC renal failure in kids - E. coli infection - Endemic = EHEC - Epidemic = O157:H7

Dx of vasculitis, involving sinus, lungs, and kidneys (Extra hint: saddle nose in adults)

2nd MCC in kidneys Wegener’s = granulomatosis w/ polyangiitis c-ANCA positive

Our Clues 11 Flashcards

(50 cards)